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Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique

BACKGROUND: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life....

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Autores principales: Moreno-Llorente, Pablo, Pascua-Solé, Mireia, García-Barrasa, Arantxa, Muñoz-de-Nova, José Luis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10388241/
https://www.ncbi.nlm.nih.gov/pubmed/37529659
http://dx.doi.org/10.3389/fsurg.2023.1217764
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author Moreno-Llorente, Pablo
Pascua-Solé, Mireia
García-Barrasa, Arantxa
Muñoz-de-Nova, José Luis
author_facet Moreno-Llorente, Pablo
Pascua-Solé, Mireia
García-Barrasa, Arantxa
Muñoz-de-Nova, José Luis
author_sort Moreno-Llorente, Pablo
collection PubMed
description BACKGROUND: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life. Any surgical innovation that could reduce complications and improve outcomes of patients undergoing total thyroidectomy deserves to be considered. Angiography-Guided Thyroidectomy has been proposed as a modification of the standard technique of thyroidectomy aimed to identifying the vascular pattern of the parathyroid glands to maximize efforts for preserving functioning glands at the time of operation. Our aim is to provide a technical description of this procedure based on the use of indocyanine green (ICG) angiography to standardize this technique. METHODS: The surgical steps that are followed during a total thyroidectomy are modified due to previous visualization of the feeding vessels of the parathyroid glands according to fluorescence of the vascular mapping obtained by ICG angiography prior to thyroidectomy. The first step is to perform an ICG angiography to assess anatomical features of the feeding vasculature of the parathyroid glands, which allows precise surgical dissection for preservation of the glands. Once the viability of the parathyroids has been evaluated angiographically, thyroidectomy is performed in a second step. CONCLUSIONS: ICG angiography-guided thyroidectomy may be effective to preserve the largest number of better perfused parathyroid glands, which would contribute to reduce the risk of postoperative and permanent hypoparathyroidism. It can be successfully and safely implemented in thyroid surgery and standardization of the technique is necessary to homogenize this procedure in the future, allowing a better comparation of the results to be published.
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spelling pubmed-103882412023-08-01 Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique Moreno-Llorente, Pablo Pascua-Solé, Mireia García-Barrasa, Arantxa Muñoz-de-Nova, José Luis Front Surg Surgery BACKGROUND: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life. Any surgical innovation that could reduce complications and improve outcomes of patients undergoing total thyroidectomy deserves to be considered. Angiography-Guided Thyroidectomy has been proposed as a modification of the standard technique of thyroidectomy aimed to identifying the vascular pattern of the parathyroid glands to maximize efforts for preserving functioning glands at the time of operation. Our aim is to provide a technical description of this procedure based on the use of indocyanine green (ICG) angiography to standardize this technique. METHODS: The surgical steps that are followed during a total thyroidectomy are modified due to previous visualization of the feeding vessels of the parathyroid glands according to fluorescence of the vascular mapping obtained by ICG angiography prior to thyroidectomy. The first step is to perform an ICG angiography to assess anatomical features of the feeding vasculature of the parathyroid glands, which allows precise surgical dissection for preservation of the glands. Once the viability of the parathyroids has been evaluated angiographically, thyroidectomy is performed in a second step. CONCLUSIONS: ICG angiography-guided thyroidectomy may be effective to preserve the largest number of better perfused parathyroid glands, which would contribute to reduce the risk of postoperative and permanent hypoparathyroidism. It can be successfully and safely implemented in thyroid surgery and standardization of the technique is necessary to homogenize this procedure in the future, allowing a better comparation of the results to be published. Frontiers Media S.A. 2023-07-17 /pmc/articles/PMC10388241/ /pubmed/37529659 http://dx.doi.org/10.3389/fsurg.2023.1217764 Text en © 2023 Moreno-Llorente, Pascua-Solé, García-Barrasa and Muñoz-de-Nova. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Moreno-Llorente, Pablo
Pascua-Solé, Mireia
García-Barrasa, Arantxa
Muñoz-de-Nova, José Luis
Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title_full Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title_fullStr Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title_full_unstemmed Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title_short Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique
title_sort indocyanine green (icg) angiography-guided thyroidectomy: description of surgical technique
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10388241/
https://www.ncbi.nlm.nih.gov/pubmed/37529659
http://dx.doi.org/10.3389/fsurg.2023.1217764
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